title: Ischemic stroke in patients with solid gynecologic tract tumors and coagulopathy.
abstract: OBJECTIVE
  Patients with gynecological neoplasms often suffer ischemic stroke. This study aimed to clarify the underlying mechanisms of ischemic stroke in patients with gynecological tract tumors.
  
  
  METHODS
  We retrospectively reviewed 6 patients with gynecologic tumors and hypercoagulability who were being treated for acute ischemic stroke between 2006 and 2012. Diffusion-weighted magnetic resonance imaging (DW-MRI), cardiovascular risk factors including plasma D-dimer levels, and histologic examination of the patients' solid tumors were performed. All 6 patients underwent transesophageal echocardiography (TEE) for nonbacterial thrombotic endocarditis (NBTE) and paradoxical embolism.
  
  
  RESULTS
  All 6 patients showed elevated plasma D-dimer levels. In 1 patient, paradoxical embolism was diagnosed. In the remaining 5 patients, DW-MRI scans showed numerous lesions in multiple vascular territories, and in 4 of these 5 patients, TEE demonstrated vegetations on the mitral valve, leading to the diagnosis of NBTE. Interestingly, 2 of these 4 patients had benign uterine tumors, whereas the other 2 had ovarian cancer.
  
  
  CONCLUSIONS
  NBTE was the main etiology for ischemic stroke in patients with gynecologic tract tumors and coagulopathy. Both malignant and benign tumors of the gynecologic tract can cause NBTE.
authors.affiliation: Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tadokoro
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakaguchi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yagita
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Furukado
authors.forename: Shuhei
authors.initials: S
authors.lastname: Okazaki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Fujinaka
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
authors.forename: Hideki
authors.initials: H
authors.lastname: Mochizuki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
mesh_terms: D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000150:complications*; D017548:Echocardiography, Transesophageal / Q000379:methods; D004696:Endocarditis / Q000150:complications*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D